F0627

D

Failure to Readmit Hospitalized Resident Due to Insurance Lapse

Sacramento, California Survey Completed on 03-12-2026

Penalty

No penalty information released

Summary

The facility failed to allow a resident to return after a hospital transfer, despite the resident being medically stable and a bed being available. The resident had been admitted with ESRD and DM and was transferred to the emergency department on 2/18/26 for evaluation and treatment of a left big toe infection with suspected osteomyelitis, as documented in the IDT note. The resident’s admission record showed a discharge date of 2/25/26 at 10:30 a.m., coinciding with the expiration of a seven-day bed-hold period while the resident remained hospitalized. Hospital case management correspondence on 3/9/26 indicated the resident was medically stable and ready to leave the hospital, and planning began for the resident to return to the facility.

According to an online complaint to CDPH, the facility administrator stated the facility was refusing to readmit the resident after hospitalization due to an insurance lapse. In interviews, the DON confirmed the resident was still considered a resident at the time of transfer to the hospital, that the facility refused readmission due to insurance issues, that there was a LTC bed available, and that there was no 30-day discharge notice, no appeal rights provided, and no discharge planning prior to hospitalization. The Admissions Coordinator also confirmed the resident was not readmitted because of lack of insurance. The facility’s own policy on readmission stated that residents discharged to the hospital would be given priority for readmission, that residents whose hospitalization exceeded the state bed-hold period would be readmitted upon first bed availability if they required the facility’s services, and that readmission procedures would apply equally regardless of payment source.